Shock wave therapy device with image production

ABSTRACT

The invention relates to a shock wave therapy device with a shock wave source for the emission of a shock wave and an ultrasound unit for obtaining image information by means of the emission and reception of ultrasound, whereby the ultrasound unit is provided for the reception of reflected or scattered components of the shock wave for obtaining image information. In addition, the invention relates to a method for obtaining image information for shock wave therapy with the steps: a) emitting ultrasound using an ultrasound unit, b) receiving the reflections of the emitted ultrasound using the ultrasound unit for obtaining image information, c) emitting a shock wave using a shock wave source and d) receiving reflected or scattered components of the shock wave using the ultrasound unit for obtaining image information.

The invention relates to a shock wave therapy device with a shock wave source for the emission of a shock wave and an ultrasound unit for image production by means of emission and reception of ultrasound. Furthermore, the invention relates to a method of producing image information for shock wave therapy.

In shock wave therapy, kidney or gall stones (concrements) are disintegrated by means of focussed shock waves. Other forms of shock wave therapy are the treatment of pain, the treatment of closed vessels, the treatment of the cardiac muscle, etc. in a corresponding target area. The shock wave source generally has a focus which is determined by its geometry. The focus can be generated, for example, through a lens.

In order to direct the focus of the shock wave source at the concrement or target area, it is necessary to locate the concrement or corresponding structures of the target area. Here, location using both X-rays and ultrasound is known.

From DE 203 15 924 U1, for example, a shock wave source is known where an ultrasound converter is connected with the shock wave source in a specified geometric arrangement, so that the concrement can be located with the ultrasound converter.

Because of the fixed geometric relationship, the position of the focus can be indicated by a marker, such as a cross, in the ultrasound image.

During image monitoring, the concrement or target area can be moved in relation to the focus until alignment is achieved.

The physical shock wave focus, however, is not proven and displayed using measurement technology. Incorrect adjustment of the mechanical coupling of the shock wave source can therefore cause deviations between the displayed and actual focus positions. This would lead to ineffective treatment with an increased risk of side effects. In addition, it cannot be directly detected whether the shock wave is reaching the focus to a sufficient degree. Faulty acoustic coupling between the shock wave and the body to be treated or strong reflections on, for example, ribs located above the target organ can weaken the shock wave energy applied.

It is known from DE 37 03 335 C2 that an ultrasound receiver unit in the form of a PVDF foil can be provided, with which a reflected echo can be received which occurs at a concrement when the shock wave pulse hits the concrement. The disadvantage of this is that image production is only possible with application of a shock wave pulse, but not beforehand, to allow the shock wave source to be adjusted. Moreover, this method requires a shock wave therapy device to meet certain structural preconditions, e.g. the existence of a lens.

EP 0 460 536 A1 describes a lithotripter in which no imaging is used to align the focus and the concrement; instead, a piezoelectric shock wave source is used to generate a weak ultrasound pulse and the echo is received on a time-resolved basis, so that it can be concluded from a strong echo that the position of the focus coincides with the concrement.

The disadvantage of this is that no direct image production is possible, although this is a major advantage for carrying out lithotripsy, since direct image production can be used to determine the shape, size and state of disintegration of the concrement. In addition, presenting the surrounding anatomy is important for safe treatment, since the target can only be clearly identified in this way, and adjacent risk structures can be protected.

Furthermore, an alignment of a B image with a speed image is known from DE 4113697 A1. Movements of the concrement, for example, or cavitation blistering triggered by the shock wave can be detected in this way.

The disadvantage here, however, is that movements only occur in the case of cavitations which are, in themselves, unwanted, or only when the concrement is hit by the shock wave. Otherwise, no movements can be detected and the method is thus no longer helpful.

The object of the present invention is to provide a shock wave therapy device and a method with which the position of the focus and the concrement or the target area can be monitored as cost-effectively as possible and in a way that is as least susceptible to errors as possible. This object is solved by a shock wave therapy device according to claim 1 and a method according to claim 16.

The shock wave therapy device also uses the same ultrasound unit that is used for normal image production to also register components of the shock wave for obtaining image information which are reflected or scattered in the focus area of the shock wave.

This means that it is possible to obtain an image of the shock wave focus itself. Because this shock wave focus is received with the same ultrasound unit as the normal image, optimum monitoring of the treatment is possible. The shock wave focus can be aligned with the target area or concrement without any doubt. Detection of the shock wave focus ensures that the acoustic energy of the therapy wave reaches the target.

The ultrasound unit comprises preferably an electrical transducer such as a piezoelectric transducer which can be electronically focussed. This is made up of a large number of individual elements which are arranged as either a 1-dim or 2-dim array. This type of transducer allows a high-quality ultrasound image to be obtained in a way that is cost-effective.

The ultrasound unit can also comprise two or more piezoelectric transducers which, for example, have different frequency characteristics. Each transducer, in turn, can be built up, however, from a number of transducer elements. In this way it is possible to use one transducer for normal ultrasound image production and the other for receiving components of the reflected shock wave for obtaining image information. The two transducers are grouped together in one ultrasound unit, so that their position in relation to each other is known.

The ultrasound unit can also comprise transducers which are made up of transducer elements with different properties—for example, two or more different types of transducer elements which each have different frequency characteristics. The various transducer elements can always be arranged alternately, for example. This applies for both 1-dimensional arrangements and 2-dimensional arrays.

The various ultrasound units mentioned can be linked with an electronic signal processing device which can carry out both radiation focussing and reception focussing. In radiation focussing, the individual elements of the ultrasound unit are activated after a time delay, producing an outgoing wave that is focussed. Similarly, with reception focussing, the received signals can be assigned a time delay electronically, so that the reception of ultrasound from a particular area (focus of reception focussing) is particularly intensive. In this way, scanning by line is possible both by emission focussing and by reception focussing or both at the same time. Emission focussing is not used to display the shock wave, since the shock wave is generated by the shock wave source rather than by the transducer itself. However, the reception focussing can be used to show the echoes generated by the shock wave on a location-resolved basis.

Advantageously, the shock wave therapy device is built in such a way that the image signal production by means of the emission and reception of ultrasound can take place at different times from the image signal production through the reception of the reflected and scattered parts of the shock wave. This means that electronic signal processing of the different signals is possible in each case.

For the operating staff, it is an advantage if the different image information obtained is overlapped or superimposed so that it is shown in a single image. In this way, it is, in particular, easily possible to achieve alignment of the shock wave focus with the concrement.

Piezoelectric (see DE 31 19 295 A1), electromagnetic (see DE 37 03 338A1) and electrohydraulic (see DE 36 17 032) shock wave sources are known, each of which can also be used in the present invention.

The various designs may show more or less marked imprecisions at the time when the shock wave is triggered. With the electrohydraulic shock wave source, for example, the precise time depends on the degree of contact erosion of the electrodes.

Advantageously, a corresponding sensor is therefore provided with which the precise time of the shock wave source emission can be determined so that the electronics of the ultrasound unit can switch over accordingly to the reception of reflected or scattered components of the shock wave.

In this way, it is possible to achieve the most complete flow of image production possible, i.e. to ensure that image information can be obtained immediately before the emission of the shock wave by means of emission and reception of the ultrasound by the ultrasound unit.

In the case of shock wave sources where the timing of the shock wave is known precisely, however, because this is triggered by a corresponding (e.g. electrical) signal, there can also be a direct coupling between the signal triggering for the shock wave source and the corresponding operation of the ultrasound unit for the corresponding production of images by components of the shock wave.

The piezoelectric crystals of the electronic transducers should have a receiver area that is as broad-band as possible, since then both the reception for the B image and the reception for the display of the shock wave can be optimised. For the B imaging, depending on the depth of the image area, frequencies between 2 and 8 MHz are suitable. The shock wave frequently has a very wide frequency spectrum which depends on the type of shock wave generation and the height of the shock wave pressure amplitude. As a rule, however, the maximum of the frequency spectrum is below 1 MHz. However, particularly in the shock wave focus, where non-linear effects occur because of the high pressure amplitudes, many high-frequency components are found in the range of 3 to 5 MHz, which can be used for image production. By using a broad-band transducer, it is possible to select the best frequency for the image area in each case, depending on application. These may also be different frequencies for the two different types of image information. The choice can be made by acoustic or electronic signal filtering.

Transducers or transducer elements with various frequency characteristics may also be provided here. For example, transducers or transducer elements with a good reception sensitivity below 1 MHz (reception sensitivity maximum below 1 MHz) may be provided, plus other transducers or transducer elements with a good reception sensitivity above 1 MHz, such as, for example, 2, 3, 4, 5, 6, 7, 8, 9 or 10 MHz. Instead of a good reception sensitivity below or above 1 MHz, the good reception sensitivity can also be below or above 0.5, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 6, 7, 8, 9, 9.5 or 10 MHz or in between. This depends on the various requirements. The one type of transducer or transducer elements are optimised for image production with shock waves and the others for normal B image production.

In the method for obtaining image information, for producing a B image, for example, ultrasound is emitted by an ultrasound unit and then received. Furthermore, a shock wave is emitted using a shock wave source and the reflected or scattered components of the shock wave are received with the ultrasound unit, so that image information can be obtained.

Advantageously, the shock wave source can emit shock waves with different intensities. For adjustment purposes, for example, a shock wave can be emitted with a lower intensity than a shock wave that is intended for disintegrating stones. The intensity of the shock wave for adjusting only needs to be large enough for it to be possible for the reflected and scattered components of the shock wave to be received with the ultrasound unit.

An embodiment of the shock wave therapy device and the method will be explained using the Figures. In these,

FIG. 1 shows a schematic diagram of the shock wave focus,

FIG. 2 shows a schematic diagram of the various elements in the shock wave therapy device,

FIG. 3 shows the locational relationship between the direction of spread of the shock wave, the transducer and the image point if the ultrasound unit is centrally positioned,

FIG. 4 shows the locational relationship between the direction of spread of the shock wave, the transducer and the image point if the ultrasound unit is not centrally positioned, whereby the axial axis of the shock wave source and the ultrasound image plane are in a single plane,

FIG. 5 shows a schematic diagram of the overlapping of the various items of image information,

FIG. 6 shows a schematic diagram of various ultrasound units, and

FIG. 7 shows a schematic diagram of other ultrasound units.

FIG. 1 shows the ellipsoidal isobars of a shock wave focus, for example, the −6 dB isobars relating to the focus tip value, which may be around 3 to 10 cm long in the Z direction and which is typically 2 to 15 mm wide in the X and Y direction.

The following description describes a lithotripter as an example of a shock wave therapy device. For the other treatment devices used in the treatment of pain, etc. (see above), the embodiments apply accordingly.

FIG. 2 shows the various elements of the lithotripter diagrammatically. The lithotripter comprises a shock wave source and a transducer which is used here as an ultrasound unit. The ultrasound unit can be positioned on or next to the symmetry axis of the shock wave source (see FIGS. 3 and 4). The ultrasound unit can be, for example, a linear arrangement of 128 individual piezoelectric elements. More or fewer elements can be provided, such as 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190 or 200 or more.

The shock wave source is preferably electromagnetic.

A control unit is used to control the shock wave source so that a shock wave can be emitted at controlled times. Furthermore, the control unit controls a beam former for emitting ultrasound (“transmit beam former”). This controls the transducer in such a way that, for example, by means of emission focussing, ultrasound pulses are emitted for obtaining image information on particular image lines. With emission focussing, the individual transducer elements are controlled with such a time lag that the individual transmitted ultrasound waves—also known as Huygens' individual waves—superimpose structurally at the focus point. As a rule, the individual channels are also weighted with an apodisation function in order to suppress secondary maxima. The emitted ultrasound pulse is scattered and reflected in the body. The transducer elements receive these reflections as analogue electrical signals. These are taken to a normal B image processor. The normal B image processor can be used to produce standard ultrasound images, which can be shown on a display.

If a shock wave is emitted, the emission of ultrasound pulses by the transducer can be interrupted. However, the transducer elements continue to be used for reception. The signals resulting from the shock wave echoes are forwarded to a shock wave signal processor for image production. The short-term cessation of the emission of ultrasound pulses and the forwarding of the signals as required to the B image processor or shock wave signal processor is controlled by the control unit.

Depending on the further processing by the B image processor or by the shock wave signal processor, the signal is filtered, amplified and digitised accordingly. The separated filtering and pre-amplification allows signal treatment that is suitably modified. If, for example, the intensity of the two signals is clearly different, this can be balanced out by pre-amplification that varies in strength accordingly. The filtering can limit the signal to the frequency range that is relevant in each case, in order to reduce noise, for example.

The shock wave signal processor calculates the shock wave pattern. The calculation is essentially based on the reception focussing as used basically in the case of normal B image production too.

FIG. 3 shows the geometry for when the transducer is positioned centrally in relation to the shock wave source.

Let the axial axis of the shock wave source and of the transducer—without limitation of the generality—be the Z axis. Let the position of the transducer elements be {right arrow over (r)}_(n). In order to determine the signal at an image point {right arrow over (r)}₁, the individual signals S_(n), which are picked up at the transducer elements n, are added, whereby the individual signals are phase-delayed in relation to each other.

The phase delays should be chosen in such a way that they balance out the relative path differences of {right arrow over (r)}₁ (location of reflection or scatter) to the various {right arrow over (r)}_(n) (receivers). The signal intensity S for the location {right arrow over (r)}₁ can be calculated according to $\begin{matrix} {{S\left( \overset{->}{r_{1}} \right)} = {\sum\limits_{n = 1}^{N}{{{Apod}_{n}\left( \overset{->}{r_{1}} \right)} \cdot {S_{n}\left( \frac{r_{1,z} + {{\overset{->}{r_{n}} - \overset{->}{r_{1}}}}}{c} \right)}}}} & \left( {{Equation}\quad 1} \right) \end{matrix}$ in which Apod_(n) ({right arrow over (r)}₁) is the apodisation function, S_(n) the time dependency of the intensity measured at the location r and c the speed of the spread of sound.

The apodisation function Apod_(n) ({right arrow over (r)}₁) serves to suppress secondary maxima and corresponds to the apodisations as used in conventional B image production.

In equation 1, it was assumed, through the consideration of r_(1,z), that the shock wave has an even phase front. This is actually only precisely true in the lateral plane of the shock wave focus.

However, equation 1 represents a sufficiently precise approximation for the particularly interesting areas, such as the focus area, and on and near to the axial axis. In principle, the running time of the phase front can also be indicated for any point r₁ and an exact solution can be calculated. If the transducer and shock wave axis are not parallel, but are at an angle as shown in FIG. 4, equation 1 applies similarly.

The calculation of a shock wave pattern requires extensive calculation work. However, because the shock wave rate, for example, in lithotripsy typically does not exceed 2 Hz, a pattern can actually be calculated economically today. Similarly, as with conventional B imaging, rapid approximation solutions can also be realised.

FIG. 5 shows a normal B image on the top left, showing an organ with a concrement in diagrammatic form. The organ is ellipsoid and the concrement is shown in it by a black dot.

The image of the shock wave focus as it is obtained with the above-mentioned device is shown in FIG. 5 on the top right. By superimposing or overlapping the two images which have been obtained with the same ultrasound transducer, it is thus possible to achieve a correlation not susceptible to error between the concrement and the shock wave focus.

FIG. 6 a shows an ultrasound unit 1 which comprises two transducers 2, 2′. Each transducer 2, 2′ is made up of transducer elements 3 a, 3 b, 3 c, . . . , 3 a′, 3 b′, 3 c′, . . . . Each of these transducer elements 3 a, 3 b, 3 c, . . . , 3 a′, 3 b′, 3 c′, . . . is, for example, a piezoelectric element. If necessary the transducer elements 2 are of a different size to the transducer elements 2′. The transducer elements of transducer 2 have a different frequency characteristic than the transducer elements of the transducer 2′. In this way, a transducer can be used for producing the normal ultrasound images (such as B images), whilst the other is used for the reception of the reflected and/or scattered shock wave components. The two transducers can be separately optimised for the respective requirements with their frequency characteristics (e.g. given through the resonance frequency and resonance width).

Whilst FIG. 6 a shows the case of two 1-dimensional transducers 2, 2′, FIG. 6 b shows the case of two 2-dimensional array-type transducers 4, 4′.

The direction of radiation of the transducers in FIGS. 6 and 7 is, for example, to the right in each case. The incoming acoustic signals to be received also come from the right.

FIG. 7 a shows a transducer 5 with two different types of transducer elements 6 a, 6 b, 6 c, 6 d. The transducer elements 6 a and 6 c are smaller than the transducer elements 6 b and 6 d. The different transducer elements do not need, however, to be of different sizes; they may, for example, vary in their frequency characteristics instead, or additionally. The one elements 6 a, 6 c can be used for the production of normal ultrasound images (such as B images), whilst the others 6 b, 6 d are used to receive the reflected and/or scattered shock wave components.

FIG. 7 b shows the case of a 2-dimensional transducer 7 where transducer elements of different types 8 a, 8 b are arranged next to each other, here specifically in the form of a check board. The one transducer elements 8 a are marked with a cross, to distinguish them, whilst the others 8 b are not marked.

With the method, the transducer in FIG. 2 emits and receives ultrasound. The received ultrasound is converted by the transducer into an electrical signal. A control unit controls a switch in such a way that the signal is taken, after filtering, pre-amplification and digitisation, to a B image processor. This then evaluates the images in the normal way and takes them to a display so that a map of the concrement is obtained using the transducer.

For emission focussing, a transmit beam former is used which is controlled by a control unit.

The control unit then triggers the emission of a shock wave from the shock wave source. The emission of ultrasound with the transmit beam former and the transducer is thus interrupted. Furthermore, the control unit forwards the signals from the transducer received from this time to the shock wave signal processor. The emitted shock wave is reflected and scattered in the medium to which it was sent. These reflected and/or scattered components are received by the transducer, converted into electrical signals and forwarded via the filter 2, a pre-amplifier and an A/D converter to the shock wave signal processor. As soon as these signals have died off or after a preset time, the control unit sets the transmit beam former and the transducer back to normal image production (B image) and the signals from the A/D converter are taken to the B image processor so that ultrasound images continue to be obtained.

If different transducers or transducer elements are used for B image production and signal production for the shock wave signal processor, the switch which is controlled by the control unit is no longer necessary. Both types of image production can then be carried out at the same time next to each other. This also means that the B image production does not need to be interrupted during shock wave emission. If different transducer elements of a transducer are used, however, the signals for the B image processor and the shock wave signal processor should be suitably divided, with either the digitised data or the analogue signals being divided. Correspondingly separated wiring of the different types of transducer elements can also be implemented here.

By superimposing or overlapping the image information that has been obtained with the B image processor and the shock wave signal processor (see FIG. 2) (which can be done, for example, by simply adding the image signals), these can be shown on a single screen in superposition, as shown in FIG. 5. The different items of screen information can be advantageously set separately in terms of brightness and other image parameters, so that none of the items of image information completely eclipses the others. Presentation in different colours is also possible. The superimposing the image information means that the location of the shock wave focus and the concrement can be seen immediately, so that the shock wave source or shock wave focus can be adjusted or tuned.

Image production through the emission and reception of ultrasound and through the reception of reflected or scattered components of the shock wave can be carried out several times one after another. Typically, during lithotripsy treatment, 1000 to 2000 shock waves are emitted. For each shock wave, the device switches back and forth once between the different types of image production unless both image productions can be operated at the same time.

The ultrasound unit can in principle be arranged in any way in relation to the shock wave source. However, an arrangement is advantageous in which the ultrasound takes the same pathway as the shock wave source so that the medium through which the shock wave runs can be displayed itself with the ultrasound. This can be achieved, for example, by positioning the ultrasound unit centrally in front of the shock wave source.

This is advantageous, for example, for the detection of cavitation blisters, etc., which have a negative effect on the shock wave. 

1. Shock wave therapy device with: a shock wave source for the emission of a shock wave and an ultrasound unit for obtaining image information by means of the emission and reception of ultrasound, characterised in that the ultrasound unit is provided for the reception of reflected and/or scattered components of the shock wave for obtaining image information.
 2. Shock wave therapy device according to claim 1, characterised in that it is possible to obtain image information for a shock wave focus with the ultrasound unit.
 3. Shock wave therapy device according to claim 1 or 2, characterised in that the ultrasound unit comprises one or more transducers which in turn comprises/comprise several transducer elements in each case, such as piezoelectric elements.
 4. Shock wave therapy device according to claim 3, characterised in that the electric transducer elements are arranged on a straight and/or curved e.g. arc-shaped line and/or arranged on a flat and/or curved surface.
 5. Shock wave therapy device according to one of claims 1 to 4, characterised in that the ultrasound unit comprises transducers with different frequency characteristics and/or that one or several transducers comprise transducer elements with different frequency characteristics.
 6. Shock wave therapy device according to one of claims 1 to 5, characterised in that an electronic signal processing of the signals received by the ultrasound unit is provided, with which a reception focussing can be carried out.
 7. Shock wave therapy device according to one of claims 1 to 6, characterised in that the emission and reception of the ultrasound can be carried out at different times and/or the same time as the reception of the reflected and/or scattered components of a shock wave.
 8. Shock wave therapy device according to one of claims 1 to 7, characterised in that the image information obtained by emission and reception and the image information obtained by the reception of reflected and/or scattered components of the shock wave is processed for presentation in a single image.
 9. Shock wave therapy device according to one of claims 1 to 8, characterised in that the obtaining of the image information by emission and reception of ultrasound is used to produce a B image.
 10. Shock wave therapy device according to one of claims 1 to 9, characterised in that a sensor for recording the time of the emission of a shock wave is provided.
 11. Shock wave therapy device according to one of claims 1 to 10, characterised in that the ultrasound unit for the reception of ultrasound is provided with a frequency between 1 MHz and 8 MHz.
 12. Shock wave therapy device according to one of claims 1 to 11, characterized in that initial transducer elements are provided which have a maximum reception sensitivity below a specific frequency and that second transducer elements are provided which have a maximum reception sensitivity above the specific frequency, wherein the specific frequency is for example 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5 or 10 MHz or in between.
 13. Shock wave therapy device according to one of claims 1 to 12, characterised in that the shock wave source emits shock waves with a maximum intensity at a frequency below 1 MHz.
 14. Shock wave therapy device according to one of claims 1 to 13, characterised in that the shock wave source is an electromagnetic shock wave source.
 15. Shock wave therapy device according to one of claims 1 to 14, characterised in that the ultrasound unit is arranged centrally in front of the shock wave source.
 16. Method for obtaining image information for shock wave therapy with the following steps: a) emitting ultrasound with an ultrasound unit, b) receiving the reflections of the emitted ultrasound with the ultrasound unit for obtaining image information, c) emitting of a shock wave using a shock wave source, characterised by d) receiving reflected and/or scattered components of the shock wave using the ultrasound unit for obtaining image information.
 17. Method according to claim 16, characterised in that the same transducer of the ultrasound unit receives the reflected and/or scattered components of the shock wave for further processing of the signals which also receives the reflections of the emitted ultrasound for further processing.
 18. Method according to one of claims 16 or 17, characterised in that a transducer of the ultrasound unit receives the reflected and/or scattered components of the shock wave for further processing and another transducer of the ultrasound unit receives the reflections of the emitted ultrasound for further processing.
 19. Method according to one of claims 16 to 18, characterised in that the emission and reception of the ultrasound is carried out at different times and/or at the same time as the reception of the reflected and/or scattered components of a shock wave. 